« September 2015 Issue
Focus on Pediatric Vision: Children’s Health Team Supports Win on Expanded Massachusetts Benefits
Thousands of Massachusetts children may soon have eyeglasses covered by their insurance thanks to the work of children’s advocates in the state, aided by policy analysis and testimony support from Community Catalyst’s Children’s Health Team. The win came in early September when the federal Center for Consumer Information & Insurance Oversight (CCIIO) issued its state-by-state list of proposed Essential Health Benefits (EHB) benchmark plans slated to become effective in 2017. Included in Massachusetts’ proposed benchmark plan was a new expanded pediatric vision benefit that will include eyeglasses as a covered benefit to children found to need vision correction. In the current version of Massachusetts’ EHB, the pediatric vision benefit only requires plans to cover vision screening, but not glasses.
The Affordable Care Act established CCIIO and empowered it to oversee standards for health plans in the individual and small group markets in each state by defining a benchmark plan that includes ten categories of essential health benefits. Pediatric services, including “oral and vision care,” is one of the ten. However, all these categories are very broad, and each state’s department of insurance (DOI) is given discretion to determine the level of robustness of each benefit category. As a result, there is a wide range of state-by-state interpretation as to what is minimally required under each category. In the first round of benchmark plans, which took effect in 2014 and continue in force through 2016, few states interpreted pediatric services in the broad sense, and instead simply included a dental and vision benefit as a floor. Further, a handful of states included vision benefits that were insufficient, often severely limiting access to an obvious treatment for a visual impairment – glasses. Massachusetts was the worst offender by not including a glasses benefit at all.
Eva Marie Stahl, Project Director of Children’s Health, explained, “It was a shock that you would give children a vision screening and then not provide glasses to correct a visual impairment. It was quite frustrating that you had no recourse. So, in the second round of EHB development, we built a coalition around the mission of ensuring that children would be best served with a more robust benefit to meet their vision needs.”
The opportunity to make an impact required advocates to respond quickly, as states themselves were given a short time frame to provide CCIIO with a new selection for 2017.
As Stahl recalled, “We had a very short time to mobilize the coalition, but succeeded in generating more than 70 letters from groups and individuals to the Massachusetts Division of Insurance on the issue. That early mobilization paid off because when we showed up with several parents, providers and advocates to testify on the comment day, the department officials were already well aware of the depth of support for a more robust vision benefit.”
Stahl had high praise for the chair of the Children’s Vision Mass coalition, Katherine Majzoub, RN, MBA, Northeast Regional Director of Prevent Blindness, for her energetic leadership in galvanizing advocates to provide their input. Stahl provided the policy background for the effort, including doing national research and testifying before the DOI at the public hearing. In addition, Health Care For All Massachusetts partnered in the effort, providing testimony on the general health landscape in Massachusetts, and several providers and a Head Start staff person also testified.
The key to persuading the Massachusetts DOI of their authority to require a more robust pediatric vision benefit was being able to show that three other states – California, Connecticut and Rhode Island – had already successfully adopted a stronger benchmark.
“Divisions of Insurance have a fair amount of authority, but since it is not clearly spelled out in this process, they need to be persuaded to demand more robust benefits. We are pleased that the Massachusetts DOI showed leadership in making this change, as there were few modifications proposed nationally to the previous set of EHBs. Ultimately, we’d like to see CCIIO be more descriptive in outlining for the states the most robust set of benefits feasible to meet consumers’ health care needs,” said Stahl.
A bigger picture implication of why it is important to push for stronger pediatric benefits in this second round of EHBs nationwide relates to the pending expiration of funding for the Children’s Health Insurance Program (CHIP) in September 2017. If CHIP is not extended, many families will be getting care for their children under marketplace plans governed by EHBs, so it is essential that these be strengthened to the most robust level possible.
Bruce Gore, Communications Coordinator